Provider Demographics
NPI:1548373228
Name:MCBRIDE, MICHAEL A (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:MCBRIDE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:MIKE
Other - Middle Name:A
Other - Last Name:MCBRIDE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:6994 LODDON CV
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-8517
Mailing Address - Country:US
Mailing Address - Phone:901-624-7729
Mailing Address - Fax:
Practice Address - Street 1:5336 ESTATE OFFICE DR
Practice Address - Street 2:SUITE 1
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3635
Practice Address - Country:US
Practice Address - Phone:901-681-0408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS39201223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3225981Medicare ID - Type Unspecified